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EMOTION-FOCUSED THERAPY
FOR COMPLEX TRAUMA - EFTT
Two Day Workshop
Presenter : S a n d r a C . P a i v i o , P h . D ( C a n a d a )
Department of Psychology, University of Windsor, Canada
October, 14 & 15, 2015 in Paris
This 2-days training is simultaneously translated into French by trained EFT psychologists.
Who can attend : all mental health professionals
Objectives :
1. Understand the nature of complex child abuse trauma, and the
centrality of disrupted affective processes in the long-term
effects
2. Understand the distinctive features of EFTT and how it
addresses the constellation of emotional processing difficulties
associated with complex trauma
3. Learn key interventions used to help clients confront trauma
material, reduce fear, avoidance, and shame, and express
anger at violation and grieve losses
4. Integrate aspects of EFTT into current clinical practice
Day One (AM)
The morning session will focus on the nature of complex trauma, the fundamentals of EFTT theory and
research, and the structure of therapy. The following topics will be presented:
• The nature of complex trauma including definition, prevalence, sources of disturbance, long-term effects, and
the centrality of disrupted affective processes in disturbance
• Distinctive features of EFTT compared to other treatments for complex trauma and compared to the general
model of EFT
• Emotion theory, including fundamental assumptions about the centrality of emotion in human functioning, in
general, and trauma, in particular
• Modifications to the general model of EFT specifically for trauma, including conceptualizing the Gestalt-derived
empty-chair procedure in terms of “imaginal confrontation” of perpetrators that involves both interpersonal and
exposure processes, and a greater focus on reducing fear, avoidance, and shame
• Research on EFTT, including efficacy, change processes, and development of an alternative less stressful
procedure (“empathic exploration”) which is identical to imaginal confrontation except that trauma feelings and
memories are explored exclusively in interaction with the therapist
• Assessment of types of emotions, emotional processing difficulties, and intervention principles most relevant to
EFT for complex trauma
• Introduction to the construct of client “experiencing” (exploration of feelings and meanings) as a common
change factor across therapeutic approaches and the fundamental change process and source of new
information in EFTT, including definition, role, assessment, research findings
• Structure of EFTT, including the model of resolution which identifies steps in the process of resolving
attachment injuries and is the basis for treatment, four phases of therapy and corresponding therapeutic tasks,
and basic intervention principles
A video clip of a client dealing with the suicide of her mother will illustrate steps in the process of resolving complex
interpersonal trauma, including memory evocation, the shift from anger, to grief, to forgiveness.
DAY ONE (PM)
The afternoon session will focus on the fundamental therapeutic tasks in EFTT. These include the following:
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Cultivating the alliance, including definition and components of the working alliance, goals of alliance formation
during the critical first phase of therapy, guidelines for establishing a secure attachment bond which is especially
important in trauma work
Promoting client experiencing (exploration of feelings and meanings), including developing an environment
conducive to experiencing, guidelines for deepening experiencing step-by-step, and components of an emotion
episode or scheme as aspects of experience that can be explored
Attention to emotion regulation including dysregulation and avoidance/over-control, and the role of empathy in
promoting emotion regulation capacities
A video clip of therapy with a client disclosing sexual abuse by a priest will illustrate key aspects of alliance development
during session one
The process of resolving child abuse trauma using the “imaginal confrontation” procedure, including unique features
related to work with this client group
Tools for assessing the client’s level of engagement in the IC procedure and stage in the resolution process to help
guide the intervention process
Guidelines for introducing IC for the first time which include attention to emotion regulation and strategies for reducing
client avoidance and fear
A video clip of introducing IC during session three will illustrate helping the client we viewed in the morning session to
confront memories of her mother’s suicide in therapy for the first time
The nature of adaptive anger and sadness, criteria for healthy expression of these emotions, and guidelines for
promoting their experience and expression in therapy
A video clip of therapy with a client dealing with sexual abuse by her grandfather will illustrate principles of intervention
including memory evocation, attention to emotion regulation, differentiating anger and sadness, accessing shame and
self-soothing
DAY TWO (AM)
The second morning will first focus on the “empathic exploration” (EE) procedure which was developed as a
less stressful alternative for the significant minority of clients who are unwilling or unable to engage in IC. This
will be followed by a focus on strategies for reducing fear, avoidance, and shame during the second phase of
therapy. The following topics will be covered:
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Description of the EE procedure, including intervention principles, steps in the process, indicators for
implementing EE as opposed to IC, and guidelines for conducting the procedure
Two video clips will illustrate (1) switching from IC to EE with a highly distressed client recalling the severe physical
abuse of her brother, and (2) the introduction of EE during session four with a client who had been sexually abused by a
priest, including memory evocation, emotion regulation and intensification, meaning exploration, and identifying markers
of self-blame for subsequent therapeutic work.
• The nature of fear and shame as functionally equivalent emotions, intervention principles common to these
emotions
• Varieties of shame experience and interventions specifically for reducing shame, including affirmation of
vulnerability, two-chair dialogue, and memory work
• Strategies for accessing self-soothing
• Varieties of intra-psychic conflicts observed in therapy for complex trauma, including self-criticism, catastrophic
expectations, self-interruption
• Steps in the process of resolving self-criticism and self-blame using a two-chair procedure
• Special considerations in working with personality disorders and severe affect dysregulation
A video clip of therapy with a client who had been sexually abused by her father will illustrate steps in the process of
reducing self-blame for not having protected siblings from abuse using the two-chair procedure
DAY TWO (PM)
The afternoon of the second day will focus on reducing experiential avoidance and accessing self-soothing.
Then a case illustrating EFTT with a particularly challenging client will be presented, followed by a brief
discussion of therapy termination. The following topics will be covered:
• Review core therapeutic tasks highlighting the importance of promoting client experiencing and selfdevelopment,
• including the capacity for self-soothing
• Review the construct of experiencing highlighting the difference between client experiencing skills deficits and
• experiential avoidance as distinct processing difficulties that require different intervention strategies
• Steps in the process of experiential “focusing” to address client experiencing skills deficits
• Distinguish between two types of experiential avoidance involving different processing difficulties (difficulties
allowing
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emotional pain and limited access to internal experience) and different intervention strategies
Steps in the process of helping clients allow emotional pain
Intervention principles for helping clients shift from narratives that are externally-focused, to those that are more
personal and affectively-based, to those that involve exploration and construction of meaning
Steps in the process of self-soothing by accessing memories of self as a vulnerable needy child
Two video clips will illustrate (1) helping one client to allow painful feelings and memories of childhood exposure to
extreme family violence and (2) helping another client with a history of multiple types of abuse and perpetrators to shift
from an external to a more personal and affectively-based narrative. Both clips will illustrate the process of accessing
client self-soothing.
Presentation of a case of EFTT with a client who had been severely physically abused by his father, had problems with
maladaptive anger and aggression, and difficulties with interpersonal trust and allowing vulnerable experience; case
formulation and implications for therapy
Several video clips will illustrate key processes over the course of therapy with this client, including alliance rupture and
repair, collaboration on by-passing anger and focusing on more vulnerable experience; the shift from approaching, to
avoiding emotional pain, to allowing sadness.
Issues related to therapy termination
About the presenter
Sandra Paivio is Professor in the Psychology Department, Director of the Psychotherapy Research Centre at the
University of Windsor, and has 20+ years of clinical experience. She is one of the developers of emotion-focused
therapy, particularly applied to complex trauma (EFTT), and has conducted clinical trials evaluating the efficacy and
processes of change in EFTT. She is author of numerous publications on trauma and psychotherapy, including coauthor (with Les Greenberg) of Working with Emotions in Psychotherapy, author (with Antonio Pascual-Leone) of
Emotion-focused Therapy for Complex Trauma, and author (with Lynne Angus) of a forthcoming book on Narrative
Processes in Emotion-focused Therapy for Trauma. Dr. Paivio has presented numerous workshops nationally and
internationally and provided intensive graduate student and professional training in EFT and EFT specifically for trauma.
She also is an invited member of the American Psychological Association (Division 56) working group developing best
practice guidelines for complex trauma and received a Lifetime Achievement Award from the Trauma Section of the
Canadian Psychological Association (2014).
About Leslie Greenberg, PhD
Leslie Greenberg, Ph.D. is Distinguished Research Professor of Professor of Psychology at York University in Toronto,
Ontario. He is the Director of the York University Psychotherapy Research Clinic. He is the developer of an Emotionfocused approach to therapy. He has co-authored the major texts on emotion focused approaches to treatment. These
include Emotion in Psychotherapy(1986), Emotionally Focused Therapy for Couples (1988) Facilitating Emotional
Change (1993) ,Working with Emotions in Psychotherapy (1997) Emotion-focused therapy: Coaching clients to work
through emotions (2002) and Emotion-focused therapy of Depression (2006). More recently he has published Emotionfocused couples therapy: The dynamics of emotion, love and power (2008). Emotion-focused therapy: Theory and
practice 2010), Working with Narrative in Emotion-focused Therapy: Changing Stories, Healing Lives. (2011), and
Therapeutic Presence. (2011). Dr. Greenberg is a founding member of the Society of the Exploration of Psychotherapy
Integration (SEPI) and a past President of the Society for Psychotherapy Research (SPR) from which he received a
Distinguished Research Career award in 2004 as well as the Carl Rogers award of the American Psychology
Association. He also has received the Canadian Council of Professional Psychology Program Award for Excellence in
Professional Training and the Canadian Psychological Association Professional Award for distinguished contributions to
Psychology as a profession. He has been on the editorial board of many psychotherapy journals, including currently the
Journal of Consulting and Clinical Psychology, Journal of Psychotherapy Integration, Journal of Clinical Psychology,
Journal of Constructivist Psychology, Gestalt Review and the Journal of Marital and Family Therapy.
Comments on Greenberg’s work
« There is no doubt that Greenberg is both a pioneer and the field’s premier investigator in the important work of
applying the basic research on emotions to the process of psychotherapy... a fabulous compendium of strategies for
working with emotions."
Marsha M. Linehan, Ph.D.
"Immensely valuable [for] psychotherapists of all persuasions... theoretically innovative and clinically practical."
Michael J. Mahoney, Ph.D.
"Most psychotherapists and theories of psychotherapy recognize, in one way or another, the centrality of emotion in
both psychopathology and therapeutic change. [Dr.Greenberg’s] ‘emotionally focused’ therapeutic approach [is
one] that virtually all therapists will find useful."
Morris Eagle, Ph.D.
"Although emotion has long been recognized as playing a significant role in the development, maintenance and change
of most clinical problems, the guidelines for working with emotions therapeutically have always left something to be
desired. Not so with [those of] Greenberg... [his are] lucid, jargon-free... a landmark contribution."
Marvin R. Goldfried, Ph.D.
"Truly outstanding work [for] every researcher and practitioner involved with psychotherapy."
David H. Barlow, Ph.D.
Comments on book: Emotion-focused therapy: Coaching clients to work through their feelings.
“This book is a must for psychotherapists of all theoretical orientations” Louis Castonguay,
Associate Professor, Pennsylvania State University, President of North American Society of Psychotherapy
Research
“An excellent complement to the traditional work of cognitive-behavior therapists” Arthur Bohart , Professor of
Psychology, California State university